Most people know diabetes as a condition that interferes with the body’s ability to use and store glucose, or sugar. Diabetes affects how the body regulates sugar, which can cause damage to various systems in the body including vision – in the form of diabetic eye disease.

Diabetic eye disease actually refers to a group of eye conditions that may occur for people who have diabetes. These include cataracts, glaucoma, diabetic retinopathy, and diabetic macular edema. Here, we will discuss diabetic retinopathy and diabetic macular edema.

Diabetic Retinopathy

Animation showing progression of diabetic retinopathy

The most common diabetic eye condition is diabetic retinopathy, which is caused by changes in the blood vessels in the retina. The retina is the tissue at the back of the eye that detects light and converts it into signals that are sent to the brain via the optic nerve. When blood sugar is chronically high, it can lead to damage to blood vessels in the retina by causing them to leak fluid or even bleed.

There are two types of diabetic retinopathy:

Non-proliferative retinopathy: In this earlier stage of the disease, blood vessels in the retina are weakened. Small areas of swelling occur in the retina’s blood vessels. These areas, called micro aneurysms, may leak fluid from vessels into the retina.

Proliferative diabetic retinopathy (PDR): The more advanced stage, PDR triggers the spread, or proliferation, of new blood vessels. These new blood vessels are fragile, and more likely to leak and bleed. This may create new scar tissue that can cause retinal detachment, which may lead to permanent loss of vision.

From Diabetic Retinopathy to Diabetic Macular Edema

Swelling around the retina causes a condition called macular edema

For people with diabetic retinopathy, loss of vision most often occurs through diabetic macular edema, or DME. This describes a buildup of fluid (edema) in the region around the retina called the macula, which is responsible for the straight-ahead vision used in everyday tasks such as driving and reading. Though DME can happen at any stage of diabetic retinopathy, it occurs most often in advanced cases. Approximately half of all people diagnosed with diabetic retinopathy develop DME, so it is very important to pay attention to changes or difficulty in vision.

Symptoms

Early stages of diabetic retinopathy may have no visual symptoms, or they may be confused with declining vision due to age. These symptoms can include blurred vision, difficulty seeing at night, seeing floaters or “spots,” and/or a persistent dark spot in vision. People with diabetes may even notice that their vision worsens, then improves, relatively quickly: if a diabetic has high blood sugar for a lengthy period, fluid can accumulate in the lens, leading to blurred vision; as blood sugar levels return to normal, this blurry vision will improve. People with diabetes who take care to control their blood sugar levels also slow the onset and development of diabetic retinopathy.

Prevention and Treatment

Diabetic retinopathy may be slowed or prevented in people with diabetes by:

Sticking to a healthy diet

Controlling blood pressure

Avoiding smoking and alcohol

Maintaining an exercise routine

Taking all prescribed medications

Some patients with diabetic retinopathy require laser surgery to seal leaky blood vessels. Optometrists are also able to administer medications that decrease inflammation or slow new blood vessels from forming. In advanced cases, surgery may be needed to fix retinal detachment or replace the fluid in the back of the eye.

Risk Factors and Diagnosis

Along with diabetes, risk factors for diabetic retinopathy include race (Hispanics and African Americans are at greater risk), medical conditions such as high blood sugar and high cholesterol, and pregnancy (during which a previously non-diabetic woman may develop gestational diabetes). Because it is difficult to detect retinopathy, the American Optometric Association recommends that people with diabetes have a comprehensive dilated eye exam once each year.

Thank you for doing this. I am not affected, but it really heartens me to see people reaching out and supporting their fellow human beings in times like this. If I can be of any help, please let me know.